Tips for Approval?

I've begun the process of getting my surgery approved through BCBS of CA, and have the following requirements:  - Letter of Medical Necessity -  Appt with nutritionist - Appt with a psychologist I have already had my primary care physician write my letter, which was submitted to the surgeon's office today.  I have been in regular care with my physician for over six years, and his letter was quite thorough. I am intending to schedule the additional two appointments needed within the next few weeks.  I also have my annual appointment schedule with my OB/GYN, and am thinking I will ask her for a letter as well, just to turn in as additional support from my medical professionals.  She has been my doctor for over four years, and has been very involved in my health and well-being. I am right on the cusp of being over the LAP-Band BMI limit, and have fallen off the bariatric diet since the holidays (story of our lives, right)?  I'm assuming I will need to lose weight before my surgery, but am curious if additional weight loss before submitting my request will make a difference in approval/denial.  Or how the weight issue itself is handled.  Is it based off the BMI information on my doctor's letter or how does that work? As well, any suggestions and/or direction any one can give to help me get approved and move on with a happy/healthier lifestyle? Thanks!

It sounds as if you have it all together - as far as getting your approval.  Just do whatever your insurance requires.

Who is your surgeon?

As long as he is approved by my insurance company, it will be Dr. Kim from US Bariatric.

Congratulations.....you're on your way. If I were you, I'd make an appointment with Dr Kim (check to make sure he's on your insurance list) and THEN make an appointment for the psych eval and the nutritionist.  He may have someone who works with him or he can recommend and then you'll know for sure the wording to the insurance company will be correct. You're on the "cusp" of being over the lap band bmi limit?  I didn't know there was a limit.  My surgeon has banded a 770 pound man who's bmi was up over 80%.  Tell me more about this limit and where you got the information.  Granted, banding isn't for everybody and if you have a lot of weight to lose (over 100 lbs), then most surgeons will tell you the band may not be for you.  Well, I lost 92 pounds the first year with the band so anything is possible. The letter from you obgyn won't hurt a thing.  Its always better to have some extra documentation rather than have the insurance company tell you they still need this, that or the other. You're on the right track and doing just fine.  Hang on for the ride.  Its a doozie. La Wanda

I was also told by my Surgeons Secretary to make aleete addressed to the Surgeon from yourseld to avise all the attempts you have througout yourlifetime to loose weight including all types of diet approved or not approved if you have attempted excercise program,and oveall that he attempts all have failed because this is something that wil assist your Insurnce Company in the Apporval process, I also am planningto put that this condition is hreditary from my father whom decsed fromMorbid Obesity and all the other co morbites that he suffere from hs weight.  I m deliberating though how mch info to put on this letter.  Ifanyone has any suggestions pleas let m Know? I am looking for as many friends to help pray for e as I also pray fo eveyone in this site to support each other. God Bless All! Esthe A. If there are any suggestions plese snd me a messge.

I posted a similar question in the Lap Band forum. My BMI is just over 40 and I just started my insurance required 6 month doctor supervised diet. My insurance (Aetna) states that if your BMI is under 40 then you need to have 2 co-morbidities, which I don't have. If I lose about 10 or 15 pounds I will be below 40. The responses to my post basically said that Aetna is mainly going to look at what my weight is at the start of the process. In my case they want to see that I can make an effort with the 6 month plan, so if I go under 40 then it's only showing them that I can make the Band work as well and they're not waisting their money on my surgery. I'm sure everyone who told me that is right, but I am still going to call Aetna to make sure. I would recommend that you contact BCBS just to be on the safe side. By the way, I went to a seminar at Celebration with Dr Kim (I found out after the fact that he is not approved by Aetna, so he will not be doing my surgery). Unlike other places that I have heard of, they don't seem to have a weight/BMI limit for the Band, it's a personal choice for you to make on your own. The impression I got from Dr. Kim at that seminar was that he is a very knowlegable man *****ally cares about the well being of his patients. I hope BCBS lets you see him. Good luck with everything.  Robin

Robin: Aetna can be very tricky.   I was at a BMI of 53 and had an approval in 4 days.  I have a friend to is probably in the same category as you and was denied.   If you have any family history of the co-morbidities, you may want your doctor to include that information.    Also with the six month plan, we found that setting up all of the appointment from the start worked great. Don't make them 4 weeks apart, just make sure you have 6 appointments in 6 consecutive months.  If you do it every 4 weeks and it a 5 week month you can really mess yourself up.   Also, for the psyche eval, I used the Psychologist that was recommended by my surgeon mainly because he has a very good understanding of the surgeries and he also is the person who holds the support group meetings.